Fazekas Gabor, Nana Petroula, Torrealba Jose I, LE Houérou Thomas, Panuccio Giuseppe, Haulon Stephan, Kölbel Tilo
Department of Vascular Medicine, German Aortic Center, University Heart and Vascular Center UKE, Hamburg, Germany -
Department of Vascular Medicine, German Aortic Center, University Heart and Vascular Center UKE, Hamburg, Germany.
J Cardiovasc Surg (Torino). 2025 Jun;66(3):239-246. doi: 10.23736/S0021-9509.25.13310-7. Epub 2025 Apr 17.
Previous PETTICOAT stents, applied in type B aortic dissections, may complicate subsequent fenestrated/branched endovascular aortic repair. This study presents the technical and clinical outcomes of f/bEVAR in chronic type A and B aortic dissections previously managed with PETTICOAT.
This case series included patients from two aortic centers, with chronic dissections managed with f/bEVAR for thoracoabdominal aneurysms following PETTICOAT. The PROCESS guidelines were followed. Technical parameters and clinical outcomes were assessed.
Eight male patients were included (63 [54-74] years). Two were managed for type I, five for type II and one for type V thoracoabdominal aneurysms. Six custom-made (two fenestrated, three branched and one combined) and two off-the-shelf branched endografts were used. Technical success was 100%. Adjunctive target vessel related procedures were performed in six cases, including pre-catheterization of stenotic renal arteries due to overlapping PETTICOAT stents, dissection flap fenestration for target vessel catheterization, in-situ fenestration after accidental celiac artery occlusion, and ballon-assisted bridging stent advancement through the PETTICOAT stent-struts. Balloon-expandable or self-expanding covered stents reinforced with balloon-expandable bare metal stents were used. No death occurred within 30 days. Two early reinterventions were performed: one relining renal bridging stent compression between the PETTICOAT stent-struts and one renal branch coiling due to bleeding. Median follow-up was 21 months. No death, reintervention or target vessel instability was detected.
According to the described experience, f/bEVAR may be successfully applied in patients with previous PETTICOAT by experienced hands. However, technical challenges, needing immediate intra-operative or early post-operative management, are frequent.
先前应用于B型主动脉夹层的PETTICOAT支架可能会使后续的开窗/分支型血管腔内主动脉修复变得复杂。本研究展示了在先前采用PETTICOAT治疗的慢性A型和B型主动脉夹层中进行开窗/分支型血管腔内主动脉修复（f/bEVAR）的技术和临床结果。
该病例系列纳入了来自两个主动脉中心的患者，这些患者在PETTICOAT治疗后因胸腹主动脉瘤接受了f/bEVAR治疗。遵循了PROCESS指南。评估了技术参数和临床结果。
纳入8名男性患者（年龄63 [54 - 74]岁）。其中2例为I型、5例为II型、1例为V型胸腹主动脉瘤。使用了6个定制的（2个开窗型、3个分支型和1个复合型）和2个现成的分支型腔内移植物。技术成功率为100%。6例患者进行了辅助性目标血管相关操作，包括因PETTICOAT支架重叠导致狭窄肾动脉的预插管、为目标血管插管进行的夹层瓣开窗、腹腔干动脉意外闭塞后的原位开窗以及通过PETTICOAT支架支柱推进球囊辅助桥接支架。使用了球囊扩张式或自膨胀式覆膜支架，并辅以球囊扩张式裸金属支架加强。30天内无死亡发生。进行了2次早期再次干预：1次是重新内衬PETTICOAT支架支柱间受压的肾桥接支架，1次是因出血对肾分支进行弹簧圈栓塞。中位随访时间为21个月。未检测到死亡、再次干预或目标血管不稳定情况。
根据所述经验，经验丰富的术者可成功地将f/bEVAR应用于先前接受过PETTICOAT治疗的患者。然而，术中或术后早期需要立即处理的技术挑战较为常见。
